AKI-CLIF-SOFA: a novel prognostic score for critically ill cirrhotic patients with acute kidney injury

Sun, Dan-Qin; Zheng, Chenfei; Liu, Wen-Yue; Poucke, Sven Van; Mao, Zhi; Shi, Ke-Qing; Wang, Xiao-Dong; Wang, Ji-Dong; Zheng, Ming-Hua

doi:10.18632/aging.101161

Cited by 11 publications

(8 citation statements)

References 34 publications

(25 reference statements)

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“…In another study conducted by Dan-Qin Sun et al [14], authors used MIMIC III database to develop a specific prognostic score for critically ill cirrhotic patients with acute kidney injury that they called the acute kidney injury -Chronic Liver Failure -Sequential Organ Failure-Assessment score (AKI-CLIF-SOFA) with a valuable discriminative ability compared to other well established scores in critically ill cirrhotic patients with acute kidney injury. In another study, Hu et al [15] investigated an earlier version of MIMIC III and found that red blood cell width can be used to predict hospital mortality for acute pancreatitis patients admitted to intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

MIMIC III Database: A Descriptive Epidemiology of Severe Cholangitis Patient Cohort

Hedjoudje¹

2018

BJSTR

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Objective: Electronic medical records include detailed information on clinical care. Besides its clinical utility, they afford researchers to evaluate impact of diagnostic and therapeutic decisions on patient outcomes. However, these dataset are not shared mainly for confidential reasons and remain consequently underused. MIMIC-III ('Medical Information Mart for Intensive Care') is a large, single-center database comprising information relating to patients admitted to critical care units at a large tertiary care hospital has been made publicly available. The objective of this study is to investigate and introduce the database content though the descriptive epidemiology of a severe cholangitis patient cohort. Method:We conducted a retrospective study of patients with severe cholangitis admitted to the intensive care unit of the Beth Israel Deaconess Medical Center using the MIMIC-III v1.4 ('Medical Information Mart for Intensive Care'). We investigated type of data available in the dataset such as patient characteristics, mortality, drug prescription, microbiology data and fluid balance.Result: MIMIC-III v1.4 stores 26 different tables with an overall number of 46,520 patients accounting for 58,976 hospitalizations. Records are stored in 21 tables and 5 tables are dictionary tables. The largest file contains more than 330 millions monitoring values data. We identified 125 patients with a severe cholangitis associated with a septic shock. Mean age was 70.75 (12.57) years. 52% of patients were male. Of the 125 patients, 27 died at the hospital leading to a in-hospital mortality of 21, 77%. Patients stayed 7.1 (9.35) in intensive care unit on average. Mean fluid balance was 111. 34 (73.15), 48.34 (55.94), 34.94 (50.83), 24.25 (48.79), 27.42 (38.92), 27.73 (61.59) and 26.36 (55.66) at 24, 48, 72, 96, 120, 144 and 168 hours. The most frequent microorganism found was E. Coli on 23, 41% followed by K. pneumonia in 6,12% of specimens. Blood culture was the microbiological test most widely prescribed to check for infectious pathogens.Conclusion: MIMIC-III v1.4 is a large, single-center database that contains a very large number of patients and hospital admissions. As illustrated by the septic shock associated cholangitis patients, a very broad type of data is stored.

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Section: Discussionmentioning

confidence: 99%

MIMIC III Database: A Descriptive Epidemiology of Severe Cholangitis Patient Cohort

Hedjoudje¹

2018

BJSTR

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“…With permission, we were allowed access to medical records of patients treated in the ICU from 2001 to 2012 at Beth Israel Deaconess Medical Center (our certification number: 1605699). The data used were non-patient identifiable and anonymous; detailed descriptions have been reported in our previous studies 15,16…”

Section: Methodsmentioning

confidence: 99%

“…CICPs, defined as patients with critically ill cirrhosis, were enrolled in our study when admitted to the ICU. The criteria of liver cirrhosis and AKI in the present study were described in our previous studies 15–17. For patients without a serum creatinine (SCr) value prior to hospitalization, we used the first SCr value measured during hospitalization as the baseline SCr, in compliance with recommendations of the International Club of Ascites 18.…”

Section: Methodsmentioning

confidence: 99%

Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury

Sun

Zhang

Zheng

et al. 2019

Journal of Clinical and Translational Hepatology

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Background and Aims: The metabolic acid-base disorders have a high incidence of acute kidney injury (AKI) in critically ill cirrhotic patients (CICPs). The aims of our study were to ascertain the composition of metabolic acidosis of CICPs with AKI and explore its relationship with hospital mortality. Methods: Three-hundred and eighty consecutive CICPs with AKI were eligible for the cohort study. Demographic, clinical and laboratory parameters were recorded and arterial acid-base state was analyzed by the Stewart and Gilfix methodology. Results: Net metabolic acidosis, lactic acidosis, acidosis owing to unmeasured anions, acidemia, and dilutional acidosis were less frequent in the non-survival group compared to the survival group of CICPs. The presence of acidemia, acidosis owing to unmeasured anions, and lactic acidosis were independently associated with increased risk of intensive care unit 30-day mortality, with hazard ratios of 2.11 (95% confidence interval (CI): 1.43–3.12), 3.38 (95% CI: 2.36–4.84), and 2.16 (95% CI: 1.47–3.35), respectively. After full adjustment for confounders, the relationship between acidosis owing to unmeasured anions with hospital mortality was still significant, with hazard ratio of 2.29 (95% CI: 1.22–4.30). Furthermore, arterial lactate concentration in combination with chronic liver failure-sequential organ failure assessment and BE UMA had the strongest ability to differentiate 30-day mortality (area under the receiver operating characteristic curve: 0.79, 95% CI: 0.74–0.83). Conclusions: CICPs with AKI exhibit a complex metabolic acidosis during intensive care unit admission. Lactic acidosis and BE UMA , novel markers of acid-base disorders, show promise in predicting mortality rate of CICPs with AKI.

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“…(13) For patients without an available creatinine value before admission, we followed the recommendations of the International Club of Ascites and used the first creatinine value measured during hospitalization as the baseline creatinine. (19,20)…”

Section: Definitionmentioning

confidence: 99%

Remodeling the model for end‐stage liver disease for predicting mortality risk in critically ill patients with cirrhosis and acute kidney injury

Zhou

Chen

Sun

et al. 2017

Hepatology Communications

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Serum creatinine measurement demonstrates a poor specificity and sensitivity for the early diagnosis of acute kidney injury (AKI) in patients with cirrhosis. The existing model for end‐stage liver disease (MELD) score reveals multiple pitfalls in critically ill patients with cirrhosis and acute kidney injury (CAKI). The aim of this study was to re‐evaluate the role of creatinine values in the existing MELD score and to develop a novel score for CAKI, named the “acute kidney injury–model for end‐stage liver disease score” (AKI‐MELD score). We extracted 651 CAKI from the Multiparameter Intelligent Monitoring in Intensive Care database. A time‐dependent Cox regression analysis was performed for developing remodeled MELD scores (Reweight‐MELD score, Del‐Cr‐MELD score, and AKI‐MELD score). The area under the receiver operating characteristic curve provided the discriminative power of scoring models related to outcome. The hazard ratio of creatinine was 1.104 (95% confidence interval [CI], 0.945‐1.290; P = 0.211). Reweight‐MELD score and Del‐Cr‐MELD score (decreasing the weight of creatinine) were superior to the original MELD score (all P < 0.001). The new AKI‐MELD score consists of bilirubin, the international normalized ratio, and the ratio of creatinine in 48 hours to creatinine at admission. It had competitive discriminative ability for predicting mortality (area under the receiver operating characteristic curve, 0.720 [95% CI, 0.653‐0.762] at 30 days, 0.688 [95% CI, 0.630‐0.742] at 90 days, and 0.671 [95% CI, 0.612‐0.725] at 1 year). Further, AKI‐MELD score had significantly higher predictive ability in comparison with MELD score, MELD‐Na score, and Updated MELD score (all P < 0.001). Conclusion: The predictive value of creatinine for CAKI should be re‐evaluated. AKI‐MELD score is a potentially reliable tool to determine the prognosis for mortality of CAKI. (Hepatology Communications 2017;1:748–756)

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AKI-CLIF-SOFA: a novel prognostic score for critically ill cirrhotic patients with acute kidney injury

Cited by 11 publications

References 34 publications

MIMIC III Database: A Descriptive Epidemiology of Severe Cholangitis Patient Cohort

MIMIC III Database: A Descriptive Epidemiology of Severe Cholangitis Patient Cohort

Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury

Remodeling the model for end‐stage liver disease for predicting mortality risk in critically ill patients with cirrhosis and acute kidney injury

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